Cornerstone ADHD Treatment Could Increase Risk of Cardiovascular Problems in Children

Jennifer G. Allen
Published Online: Tuesday, June 14th, 2016
The cornerstone attention-deficit/hyperactivity disorder (ADHD) treatment could be associated with heart problems in children and adolescents, recent study results suggest.
According to the CDC, 3.5 million US children aged 4 to 17 years who have been diagnosed with ADHD have received a stimulant drug, which is usually methylphenidate (Ritalin) because it’s considered a first-line treatment for ADHD in children, despite debate over its safety profile.
Previous studies and case reports have documented a link between methylphenidate use and adverse cardiovascular (CV) events, such as heart failure (HF) and small, yet significant, increases in blood pressure. However, findings from other studies have demonstrated no significant increase in these risks, primarily because the absolute risk of CV events in children and adolescents is very low to begin with.
Nevertheless, the researchers behind a recent study published in BMJ said the benefits of methylphenidate should be “carefully weighed against the potential [CV] risks of these drugs in” this patient population. They sought to add to the literature investigating methylphenidate’s potential CV risks.
Data were derived from the South Korea National Health Insurance Database, and
1124 patients aged 17 years or younger were ultimately identified for the study. All patients had experienced a CV event and had been prescribed methylphenidate for ADHD at least once.
Of the cohort, 864 patients experienced arrhythmia, 396 patients had hypertension, 52 had experienced myocardial infarction, 67 had ischemic stroke, and 44 had HF. The incidence rates for hypertension, ischemic stroke, and HF weren’t statistically significant.
When the results were controlled for time on treatment, however, they showed that the risk of arrhythmia was significantly higher in the 2 months following methylphenidate initiation, and it was highest for children with congenital heart disease.
Overall, the researchers believed their findings were consistent with the biological plausibility that methylphenidate’s mechanism of action may affect heart rate. In light of these potential adverse CV effects, clinicians may want to consider the risk-benefit balance before prescribing methylphenidate to children and adolescents.
Study co-author Nicole Pratt, PhD, told Contemporary Clinic that weighing risks and benefits is particularly important for younger children with a history of heart disease or young patients taking medications that can affect the QT interval.
 “Health practitioners should consider the severity of ADHD symptoms and the option of nonstimulant treatment for children with high [CV] risk, particularly where ADHD symptoms are mild,” she explained.
For some younger patients, “methylphenidate may be the most effective treatment to maintain well-being and development,” Dr. Pratt continued. However, she said, “these children should be carefully monitored for any signs or symptoms of adverse cardiac effect.”
Parents shouldn’t stop their children from taking their ADHD medications without first consulting a health care professional. Retail clinicians can explain the monitoring strategies available to minimize the risk of children experiencing an adverse event potentially related to methylphenidate.
“When the medicine is deemed necessary, children should have blood pressure and heart rate monitored to help mitigate any potential risk,” Dr. Pratt explained.

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